AGRANULOCYTOSIS

1512 tissue. The resulting oedema is followed necrosis and ulceration of the mucosa. localised by Datta considers that the protozoa attacks the endothelial lining of blood-vessels, thus producing the primary lesion. When ulceration takes place these organisms are released into the lumen of the bladder after which an unsuccessful attempt at healing occurs. He also considers that the course run by enzootic haematuria and the histological changes which occur show striking similarities to those of other amoeboid infections. The parasite which he describes is to be found in both free and encysted forms. The cytoplasm is amoeboid in form and contains a nucleus, karyosome, vacuoles, inclusion bodies, and ingested erythrocytes and particulate matter. Nuclear division has been demonstrated. Free forms vary in size from 10 to 60 microns, these being the smallest and greatest diameters measured. Cysts are somewhat smaller than free forms. It is thought that the organism falls into the genus entamoeba. No report is given of the success of efforts to transmit haematuria artificially by means of this organism, but experiments with this object are being made.

perivascular

BCG VACCINATION

IN SWEDEN

IN 1927 the Swedish National Association against Tuberculosis initiated and paid for a comprehensive scheme of vaccination with B C G among the newborn infants of a district in the north of Sweden much ravaged by tuberculosis. The technique was that recommended by Calmette. Up to the end of 1933 the infants born in this district during this experiment, which is still proceeding, numbered

29,338, of whom 7765,

or 26’5 per cent., were given In the same period there were 319 deaths among the vaccinated and 2101 among the controls, -death-rates of 4’3 and 10’8 per cent. respectively. The difference was less conspicuous when the deaths during the first five days of life were eliminated, but even then it was as great as 4’1 to 8-8 per cent. When the deaths were classified according to the ages at which they occurred, it was found that the difference between the two death-rates diminished with age ; in the first year of life it was as 3’8 to 10’9 per cent., whereas in the second year it was as 1 to 2’1per cent. In the third year it was as 0’5 to 0’88 per cent. The tuberculosis death-rate in the period under review was 0’1 per cent. for the vaccinated and 0’5 per cent. for the controls. The difference between the tuberculosis death-rates in the two groups was greatest among the oldest children. A classification of the deaths according as they were due to tuberculosis or other causes showed that B C G vaccination added little or nothing to immunity to infectious diseases other than tuberculosis. It has been maintained in some quarters that children given B C G are apt, as a class, to be more robust from the outset. To test the validity of this hypothesis, all the deaths from congenital debility were excluded from the statistics, and yet the difference between the deathrates among the vaccinated and the controls was as 3’8 to 6’8 per cent. Another explanation for the comparatively low death-rate of the B C G group is that the children in it enjoy greater care than the controls. Prof. Carl Naeslund,l who supplies the above-mentioned statistics, is not prepared to dismiss this explanation as invalid, but he adds that his colleague, Dr. Tornblom, who has been in close touch with the families concerned, believes that the children in the two groups enjoy the same care. Naeslund is not prepared to draw any conclusions

B C G.

1 Nord. Med. Tidskrift, April 20th, 1935, p. 616.

from his material with regard to any immunity to tuberculosis which may be conferred by B C G ; the unknown factors in this problem are too numerous to justify any such conclusion. But he feels sure that somehow or other B C G vaccination is of value in the campaign against tuberculosis. And he claims that after more than seven years’ experience, nothing has happened to convict B C G of any ill-

effects. AGRANULOCYTOSIS FROM Denmark Dr. C. Holten contributes further 0 bservations1 to what is known of agranulocytosis. It has been recognised for some time that more this disease, and women than men suffer from Schultz, who described it as an entity in 1922, was inclined at first to think it was confined to middle-

Holten’s investigations, however, women. approach the problem of sex-incidence from a new angle. He finds that among the 3054 patients treated in his hospital in 1932 and 1933, a total of 352 were given amidopyrin (Pyramidon), and as many as 239 of these were women. In other words, the number of women receiving this drug was twice as great as the number of men, and if this ratio exists elsewhere, a simple explanation would be found for much, if not all, of the greater incidence among women. As 5 of the 352 patients developed agranulocytosis, anyone innocent of the pitfalls of statistics might be tempted to calculate that the risk of contracting agranulocytosis after taking amidopyrin is as 1 in 70 ; but Holten considers this an over-estimate of the danger, and would easily find support in this opinion. He also goes into the question whether agranulocytosis is a new disease,

aged

and is inclined to conclude that it is. In this connexion he refers to the retrospective comb-out by Lichtenstein of the records of the Stockholm fever hospital between 1916 and 1925. Among the 34,417 patients treated in this period there were 1449 deaths, but in the first five years not one of these could be considered as due to overlooked agranulocytosis. In the next five-year period there were at most 5 deaths-and probably only 1 or 2-which could be traced to this cause. Between 1926 and 1931, however, as many as 26 cases of agranulocytosis The experiwere diagnosed as such in this hospital. ences of the Blegdam’s Hospital in Denmark point the same way, and the more conclusively as in this hospital blood examinations have long been carried out as a routine when any necrotic condition is found in mouth and throat. Here the absence, until the last few years, of records of what is now recognised as agranulocytosis can hardly be attributed to

an

oversight.

NARCOTIC ADDICTION IN INDIA

WRITING on drug-addiction in India Lieut.-Colonel traces the history of the habitual use of narcotics from early times, but deals more particularly with experience since the report of the Royal Commission on the opium question in 1895, gained under the auspices of the Indian Research Fund Association. While the consumption of opium in British India is less than half what it was twenty years ago the administration of the drug to infants is still prevalent, and "is probably a cause of the high infant mortality in some communities." Thus " in Berar it is stated that 75 per cent. of the infants are doped with opium and 25 per cent. of the total opium consumed goes to infants." Addiction to

Chopra2

2

1 Nord. Med. Tidskr., 1934. viii., 1659. Chopra, R.N. : Indian Med. Gaz., March, 1935, p. 121.